Harnessing patient narratives to promote opioid tapering in primary care Project Summary / Abstract Over the past two decades, increased opioid use for chronic pain has led to a rapid rise in serious opioid- related harms, including death, without clear evidence of any corresponding patient benefit. Thus many patients on opioids for chronic pain (the largest group of which are patients with chronic neck and/or low back pain) need to be tapered either off or down to safer doses. Patients and primary care clinicians, who prescribe the majority of opioids for chronic pain, both report that opioid tapering is a difficult and charged topic marked by frequent disagreements. Thus, there is a critical need for interventions that facilitate productive discussions about opioids and persuade patients to initiate tapering while maintaining the therapeutic relationship needed for optimal care of patients' other medical problems. The overarching hypothesis for this R21 is that persuasive videos showing real patients telling their personal stories about opioid tapering can be used to design an effective patient intervention to increase opioid tapering rates. Story-based interventions have been developed for other clinical problems and are likely to be effective for opioid tapering if the stories used are persuasive to the patients who view them. The overall goals of this proposal are to a) fill a knowledge gap about patients' experiences with opioid tapering, b) identify video-recorded stories that patients find persuasive, both overall and for patients subgroups defined by gender and public versus private health insurance, and c) inform design of an opioid tapering intervention that can be tested in a future clinical trial. Study participants will be primary care patients with chronic neck and/or low back pain who have been recommended for, are undergoing, or have recently finished an opioid taper. They will participate in a series of focus groups designed to elicit their experiences with tapering in the form of personal stories. The 2-3 most compelling storytellers from each group will be identified and asked to return for individual video-recorded interviews, during which they will re-tell their personal stories about tapering. Forty-eight additional patients on opioids for chronic neck or low back pain (stratified by gender and by private versus public health insurance) will then watch and give feedback on the individual stories recorded during these interviews. They will rate each story's overall persuasiveness, identify the topics discussed, and comment on why they found each story persuasive or not. Ratings of persuasiveness as well as thematic content and patient comments will be analyzed to identify the stories that are most persuasive and to explore differences across patient subgroups. This proposal will result in identification of stories about tapering that patients find highly persuasive and so can form the basis for an innovative, story-based tapering intervention. The proposed research will also generate data on recruiting, feasibility, and the optimal target population for a future R01 proposal. This proposal advances a line of research that will result in an innovative intervention to facilitate opioid tapering in primary care, with the long- term goal of reducing prescription opioid misuse and opioid-related harms among patients with chronic pain.